Congenital anomalies of lower urinary tract trauma.

1. Congenital anomalies of lower urinary tract
Dr SUHAS U
MBBS, DNB Surgery, (Mch)
Department of Urology

3. EXTROPHY OF BLADDER (ECTOPIA VESICAE)
• It is a Congenital malformation.
• Lower portion of abdominal wall & anterior wall of bladder are missing so that
bladder is everted through the opening and found on lower abdomen with
continuous passage of urine to the outside.
• Male are more commonly affected.

5. Clinical features:
• Urinary dribbling
• Skin excoriation
• Infection & ulceration
• Ambiguous genitalia
• UTI
• Growth failure
Diagnosis:
 Cystoscopy
 Xray
 USG
 IVP

6. Management:
 Surgical closure of bladder within 48 hours
 Urinary diversion before reconstruction sx.
 Orthopaedic sx
 Supportive nursing care
 Pre op care
 Post op care
 Follow up

7. Patent Urachus

8. POSTERIOR URETHRAL VALVE
 Distant urinary tract obstruction.
 Dribbling of urine, abnormal urine stream, palpable bladder, recurrent UTI,
Vomiting & Failure to thrive.
 Diagnosis: MCU, USG and Endoscopy
 Mx: Catheterisation, balloon catheter or endoscopic fulgration, pyelostomy

10. EPISPADIAS
 Abnormal urethral opening on the dorsal aspect of penis.
 Due to abnormal development of infraumblical wall & upper wall of urethra.
 Rare in females.
CLASSIFICATION:
 Anterior epispadias
 Posterior epispadias
 Bifid clitoris (in female)
 Subsymphyseal with incontinence

11.  Management : surgery
1. 1 and half to 2years – penile lengthening; urethral strip elongation; chordee
correction.
2. 6months later – urethral reconstruction.
3. 3-4years age – bladder neck reconstruction and correction of VUR.
4. Cystoplasty and supportive care.

12. HYPOSPADIAS
 It is a congenital abnormal urethral opening over ventral aspect of penis.
 Common in male children.
Classification:
 Anterior hypospadias (65-70%) – found in glandular or coronal or distal penile
shaft.
 Middle (10-15%)penile shaft hypospadias
 Posterior hypospadias (20%)– proximal penile shaft, scrotal or perineal type.

13. Problems related to hypospadiasis:
1. Painful downward curvature of penis
2. Deflected stream of urine
3. Inability to void while standing.
Management:
 Surgical correction.

14. Phimosis
 Narrow opening of the prepuce that prevents it being drawn back over the
glans penis.
 Management: Circumcision

15. Paraphimosis
 Inability to bring the retracted foreskin back to normal position.
 Presents with severe pain and swelling
Management:
 Dorsal slit
 Circumcision.

16. MEATAL STENOSIS
 Congenital abnormality with narrow meatus
 Due to meatal ulcer & scaring.
 Meatal dilatation or meatoplasty.